Authorization Request : Provider User's GuideAuthorization Request Workflow – diagnosis only Authorization request workflow- procedure code CCHP is responsible for providing all

Authorization Request : Provider User's Guide

Introduction 1Supported Web Browsers 1 Requesting a new user account 1 Authorization Request Workflow 2 About this manual 2 Diagnosis Only Workflow Chart 2 Procedure Code Workflow Chart 2 Authorization Request Steps 3Starting an authorization request 3 Who is the provider requesting pre-authorization? 3 What is the Request Type? 3 Who is the patient requiring the pre-authorization? 4 What is the patient’s diagnosis? 4 What procedure(s) are requested in this authorization? 5 At which facility does the service need to be performed? 5 Who is the servicing provider for the service? 6 Are there any other details? 6 Tips for Finding a Provider 7 Find a provider, patient or facility ID 7 Tips for Finding and Selecting a Code 8 Tips for selecting procedure and diagnosis codes 8 Looking up codes 8 Navigating the code results 8 Providing Additional Information 10 Update the number of requested units for a code-level level of care 10 Update additional information for a procedure code 10 Attaching Documentation Tips 11 Attach a file to a new authorization request 11 Attach a file in response to a message 11 Tips for attaching files 11 Document Clinical Indications 12 Document clinical indications for codes 12 Authorization code detail box 12 Authorization Request Clinical Indication page 12 Authorization Guideline Search page 12 Authorization Request No Guideline Applies page 12 OB Clinical Indications 13 Clinical Indication Notes 14 Add a Clinical Indication Note 14 Indication Definitions 14 Edit Indications 15 Edit indications of a draft authorization request 15 Submit / Cancel Authorization Request 16 Submit a completed authorization request 16 Cancel an authorization request 16 Tips about submitting an authorization request 16 Manage the authorization request queue 17 Filtering request queue 18 Find a review a request 18 Request status types 18 Authorization request ID number 18 Filter authorization request list 18 Tips for filtering authorization request list 18 Messages 19 Manage authorization request messages 19 View messages 19 Reply to messages and Compose 19

Table of Contents

Effective 10/08/18 Page 1

This authorization request website is a service of Cite AutoAuth Module that is provided by Children’s Community Health Plan (CCHP) to speed authorization of patient care. Use this website to:

• Prepare and submit an authorization request electronically• Receive immediate notification of whether the authorization request was approved, denied, or held for further

review.

On this website, you can perform the following actions: • Request a new user account• Start an authorization request• Provide additional information• Document clinical indications• Submit a complete authorization request• Manage the auto authorization queue• Manage auto authorization messages• Manage document attachments

Contact Information You may call CCHP at 414-266-5747 with any questions about the provider portal registration.

We welcome your feedback We value your feedback on this manual. Please forward any corrections, questions, and comments to us by email at [email protected].

Supported Web browsers The following browsers in a Windows environment are supported:

• Microsoft Internet Explorer 8, 9, 10• Google Chrome

If you are not using a compatible browser, a warning message will appear at the top of the page.

If you ignore the message, application functionality should be largely unaffected, but you may experience page layout irregularities. To stop the error message from appearing on all pages, you must close it on two pages. Select the "Close" link on the message when it appears on the login page and on the main page of the application. After being closed for both instances, the message will remain closed for the duration of your session. The next time you log in, the message will reappear. Removing the message for a session does not change the fact that you are using a browser that is not supported. See your administrator about upgrading to a supported browser.

Request a new user account 1. CCHP providers should confirm with their administrator if they need to register online or if the Site Administrator will

register for the provider.Note: the first person signing in will be deemed the Site Administrator.

2. Complete the form. All fields on the form must be completed, and the facility’s tax ID number is required.3. After submitting the form, you’ll receive a confirmation email of the submission.4. Within 30 minutes of submitting the form, you’ll receive an email to verify your email address. Click on the link to

verify your email address is valid.5. You will receive an “Email Verification Completed” email to the email address you provided.6. In approximately 3 business days, you will receive your user login information and password.7. Site Administrators may register additional users for their facilities at any time after they have registered. An

individual user will follow the above steps for email verification and login.

Introduction


About this Manual Use these general steps to create and submit an authorization request:

1. Create the core authorization request, in which you identify the request type, patient, providers, procedure anddiagnosis codes, date and place of requested services, and so on.

2. Provide additional information as specified by CCHP, if required.3. Document the clinical indications for each code to be authorized.4. Review and then submit the authorization request. You will receive the initial response back from CCHP. The

following diagrams illustrate the general workflow for creating and submitting an authorization request

Authorization Request Workflow – diagnosis only

Authorization request workflow- procedure code

CCHP is responsible for providing all medically necessary covered services under BadgerCare Plus and Together with CCHP. Some services may require a doctor’s order, a prior authorization, or a copayment.

Start Authorization Request

Enter diagnosis code only

Requested level of care selected?

YesEnter requested unit of measurement for

level of care

Document Clinical Indicators Review and Submit

No Document Clinical Indicators Review and Submit

Start Authorization Request

Enter procedure code

Requested level of care selected?

Code level unit of measurement

Enter code details: enter requested length of stay

(days), number of hours, or of unit / visits

User definedfields for

procedure codes

Yes

Enter Code Details : UDF Review and Submit

No Document Clinical Indications Review and Submit

Requested level of unit measurement

Enter requested length of stay (days), number of

hours or number of units / visits

User defined fields for procedure codes

Yes Enter Code Details: UDFs Review and Submit

No Document Clinical Indications Review and Submit

Authorization Request Workflow


When you create an authorization request, you begin by specifying the core information of the request: 1. Requesting provider2. Request type3. Patient4. Codes for one or more diagnoses and/or

procedures

5. Facility (if known)6. Requested level of care7. Attending provider

Step 1 • Select the Authorization Request tab to open the first page of the Authorization Request

Step 2 • Who is the provider requesting pre-authorization?

o Type the name of the requesting Provider or your CareWeb unique ID number. A dropdown listing ofpossible matches will appear. Select yours for it to populate the other fields.

o Each provider has a unique ID number that may be entered in the Provider Search field. If you don’t knowthe provider, you may enter “Pro-Unknown” in the field.

o If two records have the same name, and you need more information to determine which record is the

correct one, move your mouse over the information icon ( ) located at the end of a record ID. A smallinformation window appears, displaying the ID number, name, and address details for that record. Patientrecords also display the date of birth. Note that the “Patient Record Selector” window also lists the plan

eligibility dates. To close the window, simply move the mouse away from the information icon. The maynot appear with some browsers; hover near the end of the unique provider number and the information willappear.

o Tap the information icon to open the information window. Tap the window to close it.Step 3

• What is the Request Type?o Select the Request Type from the list

Authorization Request Steps


Step 3 Continued o Pre-authorization, outpatient procedures

§ Select this option when requesting a procedure that is noted on the Prior Authorization List forCCHP (https://childrenscommunityhealthplan.org/cchp). A primary diagnosis code must beentered and all procedure codes that are being requested. The procedure codes will need to bedocumented.

o Medical inpatient admission§ Select this option when requesting an admission authorization. First, enter a primary diagnosis code,

which need to be documented. There is the option to enter additional diagnosis codes, which youcan (but are not required to) document. You also have the option to enter procedure codes, butyou cannot document them.

Step 4 • Who is the patient requiring the pre-authorization?

o Type the patient name or ID number. The patient's date of birth (DOB), Eligibility and Address text boxeswill populate.

Step 5 • What is the patient’s diagnosis?

o Add one or more diagnosis codes. If a red asterisk is present, at least one diagnosis code is required. Youcan always add optional (non-required) diagnosis codes:

o Select the type of code from the Code Type list.o Only ICD-10 codes will be accepted* Note: Any diagnosis code that doesn't generate a description is an indication that the code is invalid.

o Two options for entering a diagnosis code:1. Type all or part of the diagnosis code in the Code text box.2. Type all or part of the diagnosis code description in the Description text box.

o Select the Add button. One of the following things will happen:1. If a single, exact match is found for the code or description you provided, the code and description are

automatically added to your authorization request.2. If there is more than one possible match to the code or description you provided, a window opens with

a list of codes. Locate the code you want in the list and select the corresponding link to add it to yourauthorization request.

o If there is no match, a message appears — indicating nothing was found and asking if you want the codeto be used as entered. Click OK to save the code as entered.

o If listing multiple diagnoses, select the Primary option for the code that is the primary reason for theauthorization request.

o Clear the Documentable check box if you do not want to document a non- primary diagnosis.o If the Documentable check box for the primary diagnosis is automatically selected and is inactive, you

cannot clear it. You must document the diagnosis code.o Repeat these steps until you have added all of the diagnosis codes relevant to this request.


*Note: You can remove codes at any time by selecting the Delete link for the code. You can also select Close toleave the Search Results window without selecting a code.Step 6

• What procedure(s) are requested in this Authorization?o Add one or more procedure codes if the request type is Procedure Pre-authorization or a type that requires

a procedure code. If a red asterisk is present, at least one procedure code is required. You must add allcodes requested that require an authorization1. Select the type of code from the Code Type list.

2. Do one of the following:• Type all or part of the procedure code in the Code text box.• Type all or part of the procedure code description in the Description text box.

3. Select the Add button. One of the following things will happen:• If a single, exact match is found for the code or description you provided, the code and

description are automatically added to your authorization request.• If there is more than one possible match to the code or description you provided, a

window opens with a list of codes. Locate the code you want in the list and select thecorresponding Select link to add it to your authorization request.

• If there is no match, a message appears, informing you that nothing was found and askingif you want the code to be used as entered. Click OK to save the code as entered.

4. Select the Primary option button if this code is the primary procedure for the authorization request. Ifyou enter only a single code, the system automatically selects the Primary option.

5. Clear the Documentable check box for non-primary procedure codes you do not want to document.6. Repeat these steps until you have added all of the procedure codes relevant to this request.

• Note: Do not complete if the request type is inpatient (medical: OB or behavioral health). You can remove codes atany time by selecting the Delete link for the code.

Step 7 • At which facility does the service need to be performed?

o For inpatient select the location where member has been admitted.o For all other request types select the facility location of the auth request creator.o Provide information about the place and date of the requested service: (Name and address auto-fill).o Type or select from the calendar the Date of Service.o Select the Requested Level of Care from the list — Inpatient, Outpatient or Observation.

o If the selected Requested Level of Care has a unit of measurement at the request level, type the requestedlength of care in the unit of measurement field that appears (number of hours, days, or units/visits). If it hasa unit of measurement at the code level, the unit of measurement field appears on a different page.

§ The default unit of measurement for an Inpatient Requested Level of Care is RequestedLength of Stay (number of days) and appears on the request page.


§ The default unit of measurement for an Outpatient Requested Level of Care is units or visits,and appears on a different page.

o Select the Mark as Urgent check box to indicate the authorization request needs immediate review.o An “Urgent Request” is defined as a service where the normal processing time of 15 days for

routine and not life-threatening determinations could seriously jeopardize the life, health or safetyof the member. The condition would subject the member to adverse health consequences withoutthe care or treatment that is the subject of the request.

o You can change the Mark as Urgent setting (whether selected or cleared) prior to submitting theauthorization request, but not after.

Step 8

• Who is the servicing provider for the service?o Type or select the servicing provider, using name or ID number. (Name and address auto-fill)

o For inpatient, the servicing provider can be the medical doctor or the facility the member is admitted to.For any other request type its the billing entity.

Step 9 • Are there any other details?

o In the text box, provide any nonclinical notes about the case that you think should be considered whenmaking the authorization decision. The maximum allowed is 2500 characters.

o Date format required: mm/dd/yyyy§ mm: 2 digit month, with a leading zero§ dd: 2 digit day, with a leading zero§ yyyy: 4 digit year

Step 10 • Please provide the following additional information:

o Please include the contact information for the Utilization Management Nurse that CCHP should contact for more clinical information.

o This step is required.


button.

Tips for finding a provider:

• Find a provider, patient or facility ID

o Type the name in the text box on the request page, and then select the adjoining The Record Selector window displays a list of potential matches.

§ If the feature that allows an unknown provider is active for your system, the Requesting Providermay default to an unknown provider (the "PRO-Unknown" provider record), which you canchange.

§ If two records have the same name, and you need more information to determine which record is

the correct one, mouse over the information icon located at the end of a record ID. A smallinformation window appears, displaying the ID number, name, and address details for that record.Patient records also display the date of birth. Note that the Patient Record Selector window alsolists the plan eligibility dates. To close the window, simply move the mouse away from theinformation icon.

§ Tap the information icon to open the information window. Tap the window to close it.

o Scroll down the list of names and select the Select link for the one you want.

• Tips for finding a provider, patient or facility IDo If the full name of a provider, facility, or patient is unknown — you can look it up by typing a few characters

of the first or last name (for a facility, the name or city where it is located) in the text box, and thenselecting Search and Select.

o If unable to find the correct provider, patient or facility — contact CCHP for assistance at 414-266-5707.o You can search for a different name while you're at the Record Selector page. Type all or part of the name

in the text box and select Search.o In-Network checkbox (that appears next to the Search button in the Record Selector window) to search for

only in-network attending providers and facilities.

• All required information needs to be entered prior to proceeding to next page, such as Requesting Provider ID, Request Type, Attending Provider ID, Patient ID, Facility ID, and Date of Service.

• When the page is complete, select Next. If additional information about procedure codes is required, the Authorization Code Detail page opens. Once the Authorization Request Review page opens, documentation for the patient's clinical indications for each required code from this page is allowed.

Step 11


• Tips for selecting procedure and diagnosis codeso The Documentable option is automatically selected for each code you add — if the request type supports

documentation of the respective code type. This option controls whether the code will go through theprocess of documenting clinical indications (pre-certification) or not. To exclude a code fromdocumentation (and from appearing on the Authorization Request Review page), clear theDocumentable checkbox (select the checkbox to clear it) for the code.

o This option is useful if you want to include a diagnosis or procedure code for reference, but do not want it tobe considered for authorization.

o Each code you document will receive a separate authorization decision from CCHP.• Looking up codes

1. There is an automatic code lookup feature to help you add a diagnosis or procedure code to an authorizationrequest. This feature gives you the option to enter an exact code or description, if you know it, or to look-up acode based on part of the code or one or more words in the code description.

2. To use the code look-up feature, type a value into either the Code or Description box on the AuthorizationRequest page, and then press the Add button. The system automatically begins a search for codes or codedescriptions matching the value you typed.If a single exact match to the code or words you provided is found, the associated code and description isautomatically added to your authorization request. Otherwise, you will have the option to select the code youwant from a list of potential matches, begin a new code search without selecting a code or to add the codeexactly as you typed it.

3. Remove any punctuation marks when searching for a code based on words in the description. For example, ifyou type, “infection unspecified” in the Description box, the system will not find any code matches; however, ifyou type “infection unspecified” the system will find matches.

4. You can remove a code from your authorization request at any time by selecting the associated delete link.You cannot add the same code more than once to an authorization request.

5. You can search for ICD-10 diagnosis codes, and for CPT/HCPCS and ICD-10 procedure codes, whether or notthey’re associated with an MCG guideline.

6. You can select only one code from the Code Lookup Results page. If you want to select more than one, addany others as additional codes on the Authorization Request Review page.

7. The Code Lookup Results page displays a maximum of 200 potential code matches. If you do not see the codeyou are looking for in the list, return to the Authorization Request

8. Review page and start a new search using a more specific code, or more of the words contained in the codedescription.

9. If you do not receive any entries on the Code Lookup Results page, return to the Authorization Request Reviewpage and verify that the Code Type is set to the correct type.

• Navigating the code resultso If there are more entries than will display on a single page, you will see a page navigation bar at the lower right

of the page.

o To move between pages of entries, select one of the options in the navigation bar:• First: Return to the first page of the results.• Next: Proceed to the next page of results.• Last: Jump to the last page of results.• Previous: Back up one page in the results.• Page numbers: Select the number of the page to which you want to jump to

o If you want to jump to a page greater than shown, select the last page number in the list until you see the oneyou want. For example, if you want to jump to page 7 of the results using the sample shown above, you wouldselect page number 5 first, then select page 7.

Tips for Finding and Selecting a Code


o To change the number of entries displayed on the page, select one of the options in the Show entries menu atthe top left of the page. The options are 10, 25, 50 and 100.

o To further narrow your list of code match results, type another search term (code or word) in the Search box atthe top right of the Code Lookup Results page. The list of results will be narrowed to only those codes in the listthat match both your original search term on the Authorization Request page, and the term you provide onthe Code Lookup Results page.

o You can list the results in code or code description order. To do this, select either the Code or Code Descriptionheading at the top of the page. Selecting the heading once causes the list to appear in ascending (1-10, andthen A-Z) order. Selecting the column heading again causes the list to appear in descending (Z-A, and then10-1) order.

o The list of codes automatically adjusts as you type. Type as many characters of the code or word as you needuntil you see the code you want in the list.


• Provide additional informationo Depending on the requested level of care (inpatient or outpatient), and the procedure requested, additional

information when creating an authorization request may be needed.o Update the number of requested units for a code-level of care

1. Open the Authorization Code Detail page (on the Authorization Request page, select the Next button).2. In the Code Attributes panel for the code's Detail, update the unit of measurement value (Requested

Hours, Requested Length of Stay (number of days), or Units/Visits). A separate Code Attributes panelappears for each procedure code.

3. Select the Next button. The Auto Authorization Review page opens.

*Note: If the Requested Level of Care selected for the authorization request has a code-level unit ofmeasurement, the unit of measurement field (Requested Length of Stay (number of days), or Units/Visits)appears in the Code Attributes panel on the page that appears after the initial authorization request page.The default unit of measurement for an Outpatient Requested Level of Care has a code-level unit ofmeasurement of units or visits.

• Update additional information for a procedure code1. Open the Authorization Code Detail page (on the Authorization Request page, select the Next button).2. If CCHP needs additional information at the procedure code level, these fields appear in an Additional

Information panel for each procedure code. Enter the information as needed.3. Select the Next button. The Auto Authorization Review page opens.

Providing Additional Information


• When you first open the Authorization Request Review page and/or upon completion of documentation, one or moredisclaimers from CCHP may appear for each procedure code.

• A disclaimer might provide information related to indicated codes, requesting that specific documents be attached tothe request to expedite nursing review, or detail some other request-specific action.

• Manage document attachmentso An external document attachment is enabled by CCHP; you can attach documents to an auto authorization

request at any time before and after submitting the request.1. Attach a file to a new authorization request

a. Create the request, then document each of the requested codes.b. On the Authorization Request Review page, select the Attach File button. The Upload

Episode Attachment window appears.c. Type a File Description. [Optional]d. Select Upload. When the upload is complete, the window displays the file name and

description. If you provided no file description, the file name is used as the file description.e. Select the Close button. You return to the Authorization Request Review page, which

displays the file name, description and time and date of the upload. Before you submitthe file to CCHP, you can do the following:

o Select the Open link to preview the file.o Select the Remove link to remove the file in order to upload a different file.

f. Repeat as needed to add additional files.g. Select Submit.

2. Attach a file in response to a messagea. Open the Auto Authorization Queue page (select the Auth Queue tab).b. Select the authorization number link. The Authorization Request Review page appears if

the request has been submitted.c. Select the Attach File button. The Upload Episode Attachment window appears.d. Select Browse to locate and select the file to upload.e. Type a File Description. [Optional]f. Select Upload. When the upload is complete, the window displays the file name and

description. If you provided no file description, the file name is used as the file description.g. Select the Close button. You return to the Authorization Request Review page, which

displays the file name, description and time and date of the upload. Before submitting thefile to CCHP, you can do the following:

o Select the Open link to preview the file.o Select the Remove link to remove the file in order to upload a different file.

h. Repeat as needed to add additional files.i. Select Submit.

• Tips for attaching fileso You can attach and review files of those types supported by the system and for which your computer has

the supporting software. Supported file types include:• Microsoft Word documents (.doc and .docx)• Microsoft Excel files (.xls, .xlsx)• Adobe Reader files (.pdf)• Image files (jpg, .tiff, and .gif)

o Contact your system administrator if you need additional file types supported.o You can use up to 100 characters in a file name.o You can upload files up to 5 MB in size.o After upload, you can view or delete but not edit an attached file. The system maintains a log of users who

have viewed an attachment, including the date and time viewed.

Attaching Documentation Tips


• When you document the clinical indications in an authorization request, you provide clinical information that supportsthe codes that you've submitted for authorization. During this step, you may be asked to provide additional informationabout your patient's condition.

o A list of the codes entered for authorization in the previous step will appear. You must document each of thelisted codes before you can submit the authorization request to CCHP.

• Document clinical indications for codeso Navigate to the Authorization Request Review page (open the Authorization Request page and select the Next

button. (If the Authorization Code Detail page opens, select the Next button to continue.) The AuthorizationRequest Review page opens.

o Authorization code detail box will only open when a procedure code is required (for example: when enteringDME or surgical information).

o Review the information provided. If you want to update any of the information, select the Back button to returnto the Authorization Request form.

o For each primary procedure and/or diagnosis code in the list, select Document. One of four things happens:1. If no additional documentation is needed, Edit and Remove buttons appear for the code. No further

action is required for this code.2. The Authorization Request Clinical Indication page appears if CCHP has determined which guideline to

use, and wants additional information about your request. You will be presented with bulleted optionslisting potential indications.o Select the indications that apply to your patient (add notes by clicking on the blue notepad icon

, and then select Next. o You can leave the page blank if any of the indications do not apply to your patient.

3. The Authorization Guideline Search page appears if you need to select the guideline to use for yourrequest before proceeding.

o Scroll through the list of guidelines until you find the one that best describes your authorizationrequest.

o Select the Select link for the guideline. The Authorization Request Clinical indication page appearswith a list of indications.

o Complete the clinical indication pages as described above.o If none of the guidelines on the Authorization Guideline Search page apply, select the No

Guideline Applies button. Type the patient's clinical information in the No Guideline Applies box onthe Applies page and then select the Next button. Use this box to note if there is no clinicalinformation available at the time of entry of the authorization.

4. If no guidelines are found for the code, the Authorization Request No Guideline Applies page appears.Enter your clinical documentation text or select the Back button to delete the code.Repeat this step until all the listed codes have been documented. The request for authorization is ready tobe submitted.

Document Clinical Indications


• Depending on the diagnosis and/or procedure code or codes you submitted, you might be required to documentthe clinical indications for the patient's condition. This is done through a series of pages where you select theindications that apply to your patient's case.

• You can select as many of the indications that are relevant to your patient's situation. You do not need to selectany of the indications that are displayed if they do not apply. However, you must continue through each page ofquestions by selecting Next until you see the Authorization Request Review page again.

• Only codes that were designated as "documentable" on the original request appear on the AuthorizationRequest Review page. Any other codes are considered to be informational only. You must document

• The clinical indications for each of the codes listed on this page. The Submit button at the bottom of the page willremain unavailable until the clinical indications for all codes have been documented.

• You only need to attach a specific guideline to your request once. If other codes require the same guideline, youwill have the opportunity to update any information you've already documented for the guideline.

• If you are asked to select a guideline for your request, you may see a guideline in the list in gray type that cannotbe selected. This means that your request already uses that guideline, and you cannot select it a second time.

• OB Clinical Indicationso OB Delivery Inpatient admissions require the entry of some specific information to meet the newborn

reporting requirements for the State of Wisconsin. Please enter the following information in Box 8 at thetime of building the authorization. If the information is being submitted after the authorization wascreated please insert the information in the message area:

1. Delivery type – vaginal or cesarean.2. Baby first name3. Baby last name4. Baby gender5. Baby date of birth6. Baby gestational age7. Baby weight in grams8. Is baby low birth weight Y/N

o The day the mother admits to the hospital should be the date entered as the admit date NOT the datemother delivers.

• Add a Clinical Indication Note

Document Clinical Indications


o On an Authorization Request Clinical Indication page, select the note icon ( ) at the end of the indication note

o Type the note in the text box, then select OK. The icon changes to a shaded green to indicate the

presence of the new note ( ). The note is saved when you select Next.

• You can return to a clinical indication on a previous page to add, update, or review a note by selecting Back on anAuthorization Request Clinical Indication page, or by selecting Edit on the Authorization

• Request Review page. To view a note, place your mouse cursor over the saved note icon ( ). To add another note, select the icon.

• About indication definitionso An indication definition is available for a term that appears as a blue underlined hyperlink. Select the term to view

the definition, which opens in a separate window and consists of a series of indications.o You can view indications within a definition (that is, an indication definition window may contain links to

other definitions.)o Each indication definition window remains open until you close it.o Examples of an indication definition, and a definition within a definition:

§ If reference information is available for the definition, it appears as a number in parentheses at theend of the indication term. Select the number to view the reference, which appears in a separatewindow.

§ You cannot add an indication note to an indication definition.

• Edit indications of a draft authorization request

Edit indications


1. Open the Auto Authorization Queue page (select the Auth Queue tab).

2. Set the Submission Status filter to Draft. The page displays all draft authorization requests. Selectthe authorization number link for the draft authorization request you want to re-evaluate. TheAuthorization Request page appears.

3. You can update the information on the Authorization Request Review page, if necessary,including adding more details that will be saved as notes.

4. Select the Edit button. The Authorization Code Detail page opens.5. You can update any additional information on this page if necessary.6. Select the Next button. The Authorization Request Review page appears. The page displays an

Edit button and a Remove Document button for each diagnosis or procedure code.7. Select the Edit button for the diagnosis or procedure code that requires further annotation. The

first Authorization Request Clinical Indication page appears.

8. Proceed through the pages to further annotate and document the authorization request asneeded. When documentation has been completed the Authorization Request Review pagewill appear.

9. Select the Submit button (on bottom right of screen).


• Submit a completed authorization request• Submitting your request to CCHP for evaluation is the final step in the authorization request.

1. At the Authorization Request Review page (create the request, then document codes asrequired), select the Submit button. This submits the request to CCHP for review.

2. The page changes to Auto Authorization Response. The initial decision of CCHP appears in theStatus column for each code.

3. Select Return to Auth Queue

• Cancel an authorization requesto For a draft authorization request that has the requested codes documented:

1. On the Authorization Request Review page, select the Cancel Request button. A message appears, asking forconfirmation that you want to cancel the request and notifying you that this action will remove the requestfrom the Auth Queue page.

2. Select OK, which will take you to the Auth Queue page, and does not display the request.o For a submitted authorization request:

1. On the Auto Authorization Response page, select the Cancel Request button. A message appears, asking forconfirmation that you want to cancel the request and notifying you that this action will remove the requestfrom the Auth Queue page.

2. Select OK. You return to the Auth Queue page, which no longer displays the request.• Tips about submitting an authorization request

o Once a request has been submitted:o CCHP may automatically approve or deny the request based on the information you've providedo CCHP may determine that your request requires additional review. In this case, you will see a status of "Pended"

or "No Decision Yet." Contact CCHP with any questions about this type of request.o May display one or more disclaimers, identified by the code submitted.o Each code you have documented is evaluated separately, so you will receive an authorization decision for

each of the codes submitted.o If CCHP has special code response fields, these appear on the Auto Authorization response page, in the Auto-

Authorization panel and each procedure code panel, as applicable.

Submit / Cancel Authorization Request


• The Auto Authorization Queue shows you a history of all requests that are working drafts or have been submitted.

• From the Auto Authorization Queue page, you can:o See the current status of a requesto See all requests you have submitted or are working draftso View the information in the requesto See which requests have messages (if secure messaging is enabled)o If external document attachment is enabled, manage external document attachments posted by CCHP.

• You have the option to filter or limit your list, so that only certain requests are displayed.


• Find and review a request1. Open the Auto Authorization Queue page (select the Auth Queue tab).2. If wanted, set the filters so that you only see specific types of requests (draft or submitted).3. From here, you can:

o View the current status of the request in the Status column.o View the full authorization request by selecting the link in the Authorization column.o If the submission status is Draft, the Authorization Code Selection page opens.o If the submission status is Submitted, the Authorization Request Response page opens. This page displays the

summary details of CCHP’s response, including the status for the authorization as a whole, and the status foreach documented code.

o Check if CCHP has sent a message regarding a request in the list.o Check if CCHP has attached external documentation regarding a request in the list.

• Request status typeso CCHP defines the request status types. The following table shows examples of common status types.

Status Description Pended CCHP has received your request and determined

that it requires further review No Decision Yet A request that has been submitted for authorization,

and has not yet received a decision from CCHP. It may be pending a review by CCHP. This status may also indicate that you have not yet submitted the request to CCHP.

Complete-Approved CCHP has approved the authorization request. Complete-Rejected CCHP has denied the pre-authorization request. Complete-Partial CCHP has partially approved or may not be

approved for the quantities or time period requested.

• About the authorization request ID numbero The authorization request ID number identifies a specific authorization request. It is numbered according to

CCHP's records, so the numbers that you see may not be sequential in your list. They are, however, uniqueand will not be used by any other CCHP providers. You can use this number to identify the request.

• Filter the authorization request listo At the Auto Authorization Queue page (select the Auth Queue tab), select your first criteria in the Filter by

list box. A blank text box appears.o Type or select the date, name, or status.o Select the next condition in the And list box, then provide the value you want to filter for.o Select the request status you want to filter for in the Submission Status list box, and then select Filter. The list

of requests in the summary updates to reflect your filtering choices.• Tips for filtering your authorization request queue

o You have the option to filter or limit your queue so that only certain requests are displayed. You can selectrecords with a specific:

§ Approval status§ Requested date of service§ Date the authorization request was submitted§ Patient Name§ Facility name§ Request submission status (draft or submitted)

o You can filter by any three of the above conditions at the same time. For example, you can limit yourrequest queue so that you can see only:

§ Draft requests for patients named Smith who are to be admitted to Mercy Hospital.§ Requests submitted on specific date that have been approved.§ All requests with an anticipated admit date whether approved or denied.

o Authorization requests displayed in the queue must meet all of the conditions you specify in the filters. If youdo not see the request you are looking for, try removing one or more of the filters, or make the filter moregeneral. For example, rather than filtering for patients named "Smith," filter for patients named "Smi."

o To see the entire list, select "Unfiltered" for each of the filter options.

Filtering request queue


• Manage authorization request messageso If secure messaging is enabled, you can manage messages sent to and received from CCHP, including

requests for additional information. You can compose and send a message to CCHP at any time that youneed to communicate about an authorization request, both before and after you submit the request.

o Messages appear on the View Authorization Request Messages page in the order sent, with the mostrecent at the top

• View messages1. In the Auto Authorization Queue, select the authorization number with a message icon. The Authorization

Request Review page appears if the request has an unread message from CCHP that requests additionalinformation. The Auto Authorization Response page appears if the request has no unread messages.

2. Select the Messages button, which displays the number of unread messages in parentheses. The ViewAuthorization Request Messages window appears, displaying a list of messages.

3. Select the Show all messages option to display all messages for the authorization request, or select theShow only Unread messages option to view unread messages.

4. If necessary, use the scroll bar to view the text of a long message.5. Select the Mark as Read link to indicate the message has been read. Marking a message as “read” cannot

be undone.• Reply to a message

1. On the Auto Authorization Queue page, select the authorization number with a message icon. TheAuthorization Request Review page appears if the request has an unread message from CCHP thatrequests additional information. The Auto Authorization Response page appears if the request has nounread messages.

2. Select the Messages button, which lists the number of unread messages in parentheses. The ViewAuthorization Request Messages window appears, displaying a list of messages.

3. Select the Show all messages option to display all messages for the authorization request, or select theShow only Active messages option to view unread messages.

4. Select the Reply link for the message. The Message Composition window appears.5. Select the Send button. You return to the View Authorization Request Messages window, which displays

your message at the top of the list.• Compose a message

1. On the Auto Authorization Queue page, select the authorization number link. The Auto AuthorizationResponse page appears.

2. Select the Messages button. The View Authorization Request Messages window appears.3. Select the Compose button. The Message Composition window appears.4. Type your message and select Send. You return to the View Authorization Request Messages window,

which displays your message at the top of the list.

Messages

Documents

Authorization Request : Provider User's GuideAuthorization Request Workflow – diagnosis only Authorization request workflow- procedure code CCHP is responsible for providing all